Magpie

Thursday, May 5, 2005

Meanwhile, back at the pandemic.

Okay, we don't actually have a flu pandemic yet, but a couple of stories we've read today are indicators that the clock is ticking.

First, a prominent US epidemiologist warns that the world's governments need to speed up the approval of new flu vaccines and the resources to inject them. In an article in the New England Journal of Medicine, Dr. Michael Osterholm warns that hundreds of millions of people will die in the next flu pandemic if prompt action isn't taken. [Osterholm is director for Infectious Disease Research and Policy at the University of Minnesota.]

The 'Spanish flu' pandemic of 1918 killed 100 million people worldwide. When you adjust that figure to accommodate the tripling of the global population in the last century, a similar pandemic would claim 1.7 million victims in the US and between 180 million and 360 million globally.

Governments need national and international co-ordination to prepare vaccines and the means to administer them, he [Osterholm] writes.

Vaccine research on all contagions remains basic at best, Osterholm writes. Government investment must increase, especially to develop a new process to test vaccines without using chicken eggs. That technique takes at least six months.

"We need a detailed operational blueprint of the best way to get through 12 to 24 months of a pandemic," writes Osterholm.

If a pandemic started, would world health authorities be able to stop it before it spread? If the cause is the H5N1 ('bird flu') virus, the answer is 'probably not,' given that the likely starting point for such a pandemic is Vietnam.

According to a report in Nature, bureaucratic delays will probably make it impossible to stop a pandemic in its early stages.

Klaus Stöhr, who coordinates the influenza programme of the World Health Organization (WHO), says there is only one option for extinguishing an emerging human pandemic: rapid identification of cases, and treatment of patients and all their contacts with the antiviral drug Tamiflu (oseltamivir phosphate). Modelling studies suggest this should work if action is taken quickly enough1.

The models predict that there will be only a short window of opportunity in which to act: up to 30 days after a new case is detected. But the Vietnamese health ministry often takes two to four weeks to declare cases, according to the WHO.

"This leaves just a few days to intervene, making it very unlikely that we could stop a virus," says Stöhr. "Without fast reporting and detection of cases, the world is gambling away the small (and unproven) chance we have of stopping an emerging pandemic in its tracks."

Via CBC News and Nature.

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